Global Policy Forum

By Marwaan Macan-Markar

Cambodia's entry into the World Trade Organisation (WTO) this week is triggering a debate over whether this will be a panacea or a bitter pill for the country's 170,000 people living with HIV/AIDS. On Thursday, ministers attending the 146-nation WTO meeting in Cancun, Mexico, approved Cambodia's admission, bringing to an end an eight-and-a-half year quest for membership by one of South-east Asia's poorest countries. The WTO's decision to endorse Cambodia's application - along with Nepal's - makes the first time the organisation has opened its doors to least developed countries (LDCs) since it was established in 1995.

By gaining membership in the Geneva-based WTO starting 2004, Phnom Penh hopes to give a boost to the mainstay of its export sector - garments. Officials from the garment trade - which contributed some 85 percent of the country's 1.5 billion U.S. dollars in export revenues in 2002 - have said that WTO membership will help Cambodia to attract more investment to an industry that employs over 200,000 people.

However, international humanitarian agencies like Oxfam and Medecins Sans Frontieres (MSF) are worried by the impact that being bound by WTO rules will have on Cambodians with HIV/AIDS. At the heart of their concern are the new trade rules on access to essential medicines that will come into force almost immediately after Cambodia becomes a member. Critics have said this will strangle the lifeline -- generic anti-retroviral (ARV) drugs -- that those with HIV/AIDS need. ''It is going to be hard for Cambodia to get medicines at affordable prices, and that is the price Cambodia will pay immediately for the dubious benefits of joining this club of trading nations,'' Alex Renton, spokesman for Oxfam's South-east Asia office, told IPS. The reasons are varied, according to background papers by Oxfam and MSF prepared on the eve of the WTO ministerial meeting.

For one, these analyses say, Cambodia will not be entitled to the benefits given to the 30 LDCs that have been with the WTO since its inception. ''Cambodia has been forced into immediately halting the use of affordable generic versions of new medicines, even though the Doha declaration allows LDCs to wait until at least 2016 to implement this complicated and far-reaching agreement,'' says Oxfam's report, 'Cambodia's Accession to the WTO: How the Law of the Jungle is Applied to One of the World's Poorest Nations'.

At the last WTO ministerial meeting, held in Doha, Qatar in 2001, member governments agreed in the wake of growing pressure from poor countries hit by HIV/AIDS, humanitarian agencies and activists to reconsider its rules on Trade Related Aspects of Intellectual Property Rights (TRIPS). The outcome was the 'Declaration on the TRIPS Agreement and Public Health'. which underscored the need to place people over profits when it came to dispensing medicines to patients afflicted by killer diseases, such as HIV/AIDS, in the developing world.

It meant that countries could in the event of medical emergencies work around costly patent-protected ARVs produced by the giant pharmaceutical multinationals by either importing or producing cheaper, generic versions of the anti-AIDS drugs. A cheap-drug deal was reached among WTO members ahead of the Cancun meeting, supposedly aimed at easing stringent patent rules in order to allow poor countries access to drugs for public health needs. But Oxfam says it is of little use because of the complex conditions poor countries are expected to follow if they want to benefit from generic drugs, states Oxfam.

''The case of Cambodia's accession not only demonstrates how some (WTO) members are completely disregarding their Doha commitments, but also sets a dangerous precedent for other developing countries wishing to join the WTO,'' MSF argues in its background paper. Compounding these concerns is another factor: Cambodia's main supplier of generic anti-AIDS drugs, India, is due to become TRIPS-compliant by 2005 - and this will cut off the country's current supply line of more affordable drugs.

Little wonder, then, why the prospect of cheap anti-AIDS drugs drying up has begun to unnerve some of the country's public health officials. ''This is a big concern in Cambodia, gaining access to generic drugs and to distribute it to the patients,'' Dr Tia Phalla, secretary general of the National AIDS Authority, told IPS.

The magnitude of these concerns can be understood in light of Cambodia's HIV/AIDS prevalence rate of over two percent, making it the highest of any country in Asia, according to a report by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP). There are more than 170,000 people living with HIV/AIDS in Cambodia. But the National AIDS Authority says that only 700 patients have access to the generic anti-AIDS drugs distributed by humanitarian agencies and non-governmental organisations. The limited number of those with HIV/AIDS who are on ARVs is in keeping with the average across the Asian continent, where only four percent, or about 43,000, of the one million who need the medication have access to it, states the ESCAP study. ''Worldwide, less than 10 percent of HIV/AIDS patients have access to ARVs,'' says Paul Toh, an advisor at the South-east Asia office of the Joint United Nations Programme on HIV/AIDS (UNAIDS). ''Countries like Cambodia are very reliant on imported generic drugs for their HIV/AIDS patients,'' he adds. ''To produce ARVs for all its patients would cripple the public health budget.''

Yet, critics say, pharmaceutical companies in industrialised countries rake in huge profits when governments like the United States enforce trade rules to protect the patents of the brand-name drugs the multinationals produce. According to the U.S.-based website Families USA that lobbies for affordable health care, the pharmaceutical industry is one of the most profitable U.S. industries. ''Sales of ARVs alone roughly total three billion U.S. dollars a year,'' it reveals. ''High prices have been the single biggest obstacle to providing ARV drugs to people living with HIV/AIDS,'' states the ESCAP report. ''The main patent-holding manufacturers resisted calls for lower prices and were reluctant to license production to other manufacturers.''

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